Not getting enough vitamins and minerals is a common and growing problem in the U.S. and other developed countries.

Why it matters: Micronutrient deficiencies are overlooked, and they can hinder your health, sanity, and performance. They’re associated with everything from obesity and heart disease to fatigue, depression, and impaired intelligence and performance.

Quick Housekeeping

• I hope you burned the ships this weekend.

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• Here’s what’s coming up on 2% the rest of this week:

  • Wednesday we’ll follow up on today’s post and explain why vitamin and mineral deficiencies occur in people who think they eat healthy—and the best ways to know where you stand and fix your issue.

  • Friday we’re debuting a new series that will run on the second Friday of every month. It’s called Gear Not Stuff. It will cover the best gear I’ve come across in the last month.

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Now onto today’s post …

The diet world likes to get red in the face arguing about macronutrients—carbohydrates, protein, and fat—and how much of each we should have.

But there’s been less public focus on micronutrients. And research suggests that even people who think they eat healthy often don’t get enough of some critical micronutrients.

There are 29 different micronutrients. They’re all the vitamins and minerals in food. The stuff listed at the bottom of your food’s nutrition label that’s easy to ignore. Iron, potassium, calcium, folate, zinc, iodine, vitamins A, B, C, D, E, etc.

We require them for all sorts of biological processes and functions.

And if you’re active—or overweight or dealing with a chronic disease like diabetes—you may require even more of these vitamins and minerals than nutrition labels suggest.

Ty Beal, Ph.D., has been studying micronutrients for years. He’s a Research Advisor at the Global Alliance for Improved Nutrition, a foundation that studies and tackles malnutrition worldwide.

Beal began diving into this topic in two ways: by analyzing food systems and diet questionnaires.

Both approaches are good but not great. Food systems are big and complicated, and we often don’t remember what we ate (and we surely don’t get details like portion sizes exactly right when we do remember).

So Beal got nitty-gritty. He looked at blood sample data from people in different countries worldwide. This deeper data let him see exactly what people were lacking.

We’ve long known that people in developing countries without access to many different whole foods don’t get enough vitamins and minerals.

“But we found, wow, people everywhere are deficient in micronutrients,” Beal told me. “Micronutrient deficiencies were highest, very high, in the places you would expect, like India and countries in Sub-Saharan Africa. But they were still high in the US and UK.”

In many developing countries, as many as 9 in 10 women were deficient. “And this was looking at only four micronutrients,” said Beal. “If you were to look at all 29 micronutrients, you can be pretty sure most people in those countries were deficient in something, probably multiple micronutrients. And the more you’re deficient in, the worse your health outcomes.”

In the United States—even though we have ample grocery stores and gas stations filled with thousands of different foods—32 percent of women were deficient in one of the four micronutrients Beal analyzed in the blood samples. Other data suggests more than a third of us are low in some of them. Run the odds for all 29 micronutrients, and you’re likely low in something.

Why We Lack Micronutrients

In short

Ultraprocessed food and obesity contribute to deficiencies in the developed world.

The details

It’s quite obvious why developing countries lack micronutrients. They tend to have poor access to food and often eat the same thing every day.

But there are two key reasons this problem affects the developed world (albeit to a lesser extent).

First, consider what we eat. The top sources of calories in the American diet are:

1. Grain-based desserts like cookies, cakes, donuts, etc.
2. Bread.
3. Chicken and chicken-mixed dishes.
4. Soda, energy drinks, sports drinks.
5. Pizza

“So in the United States, the average diet is really high in ultra-processed foods,” said Beal. Those foods are jam-packed with macronutrients, or calories, “but they don’t contain a lot of micronutrients.” Micronutrients are often stripped out of whole foods when we process them.

Second, Americans tend to be large, and we have high rates of chronic disease.

“Obesity and chronic disease can actually increase your need for micronutrients,” said Beal.

In a study in Nutrition Reviews, researchers analyzed the link between obesity and micronutrient deficiencies. They wrote:

“It is not clear whether specific deficiencies are increasing the risk of greater adiposity and obesity, or whether increased obesity leads to specific micronutrient deficiencies, or maybe both.”

There are a lot of factors at play here. But scientists think:

• Obesity leads to inflammation, which leads us to need more micronutrients.
• An obese person’s body might sort of “suck up” some micronutrients and store them in different tissues like fat rather than using the vitamins and minerals to function.
• Not getting enough micronutrients may hinder our ability to burn fat. For example, previous studies have shown that correcting calcium deficiencies in obese people led them to burn more fat (my opinion is that the effect would likely be minimal, but correcting any deficiency is good, so we might as well consider this).

On Wednesday, we’ll cover why and how even “healthy” diets can lack micronutrients, how to determine which ones you lack, and explain the smartest ways to get more of the key micronutrients.

How we first realized vitamin and mineral deficiencies were a problem

In short

A doctor in 1753 cured scurvy with one of the first clinical trials in history.

The details

Sailors up to the 1750s faced a severe and gross job hazard. Their gums would begin bleeding, and they’d develop sores all over their body once they’d been out on the water long enough. The condition, called scurvy, killed millions of sailors during the golden age of exploration.

There were all sorts of theories about how to cure the disease. So a Scottish physician named James Lind stepped in to test those theories. In 1753, he conducted a study.

He divided sailors into six groups that each received a different supplement: cider, diluted sulfuric acid, vinegar, sea water, two oranges and a lemon, or a medicinal mix.

“The most sudden and visible good effects were perceived from the use of oranges and lemons,” Lind wrote in the resultant report, called A Treatise of The Scurvy.

We now know scurvy is caused by not getting enough vitamin C. From then on, sailors took limes and other citrus fruits onto ships, which is why the sailors gained the nickname “limeys.”

This told us that certain foods contain specific unseen components that keep us healthy.

From there, practical research on micronutrients grew. In the 1880s, a Japanese doctor eradicated the disease beriberi among sailors by giving them iodine. This is why we still iodize salt today.

In the early 1900s, we learned more about vitamins, and minerals and the US government began fortifying common foods with micronutrients. Many diseases that killed hundreds of thousands of people every year, like pellagra, disappeared overnight.

The micronutrients we lack

In short

Many people in the developed world are low in iron, zinc, folate, potassium, magnesium, vitamin D, and Vitamin B12.

The details

Of course, modern Americans don’t experience those old extremes of micronutrient deficiencies. Like, no one gets scurvy or beriberi or pellagra anymore.

But a third of Americans don’t get enough of the following micronutrients. And by not getting enough, we set ourselves up for slower-burning harms.

Iron

• Side effects of not getting enough: Anemia, fatigue, lack of productivity, impaired cognitive function

This one’s particularly rampant in women. “Iron deficiency really stood out among women from ages 15 to 45,” said Beal. “When women menstruate, they lose a ton of iron.”

“I can't tell you the number of people who’ve found they’re iron deficient,” said Beal. “I wrote a paper about iron deficiency with a colleague of mine. She has a very healthy diet. And she was like, ‘I just got tested, and I'm iron deficient.’”

Iron deficiency can also be common among men, especially if you’re highly active.

This happened to me. A few years ago, I was running far in the heat often. I had some routine blood work done, and my red and white blood cell levels were low. I needed more iron.

Zinc

• Side effects of not getting enough: Increased risk of common illness like the flu, increased risk of chronic disease like diabetes, impaired immune system.

“Zinc deficiency occurred in about 14 percent of women in the US,” said Beal.

You may have supplemented zinc when you get sick. For example, Zicam and Cold-EEZE are both Zinc supplements. Clinical trials have shown that supplementing with zinc can help you feel better anywhere from 1 to 3 days earlier.

Folate/Vitamin B6

• Side effects of not getting enough: Birth defects, heart disease, stroke, impaired cognitive function, depression.

Most grains have folic acid added to them.

Folate is essential for women. “If you’re wanting to get pregnant or currently pregnant, not getting enough folate can put your child at high risk for many birth defects,” said Beal. “A folate deficiency can cause neural tube defects, which can be deadly.”

For the non-pregnant, a lack of folate is implicated in all sorts of ailments that impact our mind and body. Depression and impaired thinking, stroke, and heart disease.

Potassium

• Side effects of not getting enough: Heart disease (the number one killer of Americans)

Sodium is something Americans get plenty of. That’s thanks to all our processed food.

But sodium and potassium play complementary roles. Eating too much sodium and not enough potassium increases blood pressure in some people. And that can increase your risk of heart disease and early death (this is why people with heart disease are often told to eat less salt.)

It’s hard to avoid sodium today (and too little can also be a bad thing). So a good way to offset any potential harm from salt is to up your potassium intake.

Magnesium

• Side effects of not getting enough: Increased risk of diabetes, heart disease, osteoporosis.

Nearly half of Americans may need more magnesium.

Not getting enough of it has also been linked to decreased exercise performance. In those studies, people who had low magnesium levels supplemented the mineral and saw improvements in their performance and recovery.

Other research suggests magnesium can improve sleep. One review found that it helped people fall asleep faster. Another found that it improved sleep quality. This is why, for example, Momentous’ Sleep Packs contain magnesium.

Vitamin D

• Side effects of not getting enough: Weaker bones, increased risk of fracture, impaired immune system

You’d think most people would get enough vitamin D. After all, the sun is free.

But the average person spends 93 percent of their time indoors. People most at risk of vitamin D deficiencies don’t go outside often, have darker skin tones, and live at more northern latitudes.

Vitamin B12

• Side effects of not getting enough: Anemia, nerve damage, cognitive impairment.

This one is most common in vegans and vegetarians—vitamin B12 is only found in animal foods.

Thanks for reading. Wednesday we’ll cover surprising reasons why healthy diets often lack micronutrients and practical strategies to:

1. Figure out which micronutrients you lack.
2. Get more micronutrients.

Have fun, don’t die.

-Michael

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